Is Brava Necessary for Fat Transfer to Breast?
Doctor Answers 15
Brava, Fat Grafting, and Lipobanking
The important thing to understand about fat grafting is that the amount of fat that can be injected into the tissues at any single procedure is limited. Trying to graft excessive amounts of fat into the breast will be counterproductive and result in loss of most or all of the graft. The benefit of Brava is that it expands the tissues, and brings in blood supply which allows more fat to be grafted successfully in a single session. Most of the studies show that without BRAVA, an average of 200-250cc of fat can be grafted to each breast at a single procedure. Drs Khouri and Del Vecchio (Dr. Khouri developed the Brava) have shown that with BRAVA, the average can be increased up to 300-350cc with up to 90% survival (depending on how one measures fat volume). So BRAVA is not essential, but it clearly allows for a larger augmentation at a single procedure. For breast reconstruction, which I also perform with fat, I believe BRAVA is essential. With regard to banking, I do offer this as an option to patients where repeat procedures are anticipated. Our bank is an FDA registered tissue bank, and the fat is not simply frozen in a freezer but cryopreserved in a very specific manner allowing up to 90% survival of the fat. If fat is at a real premium and you are very slim, and I feel that losing even 10% is not acceptable, I will not recommend banking. On the other hand if there is more fat than I think will be needed for the procedure(s) then banking is an option, and of course the benefit is that repeat liposuction procedures are not necessary. I will be presenting my experience on using banked fat at the 1st conference of the International Society of Regenerative Plastic Surgery in Rome next week. With regard to cancer surveillance, most radiologists now accept that cancer surveillance is not impeded by fat grafting. Rubin and Yoshimura recently published a study that shows that accepted procedures like breast reduction result in more issues with regard to cancer surveillance than fat grafting.
BRAVA system and fat grafting
Although it is not a requirement for success with fat grafting, the use of the BRAVA system, (an external suction device that acts like a tissue expander to help stretch the skin) allows the plastic surgeon to graft larger volumes of fat for reconstruction. Additionally, use of the system immediately after surgery for several weeks helps allow the most optimum conditions to help promote survival of the grafted tissue. I can and have performed fat grafting for breast reconstruction without using the BRAVA system. However, the volumes that I transfer with each procedure are much smaller and the overall size of the final reconstructed breast is often an A or a B cup breast. I realize the challenge of wearing the BRAVA system and the cost of the system can be quite daunting. However, I encourage my reconstructive patients to consider this system as often as I can because I feel that the benefits far outweigh the drawbacks.
BRAVA and fat grafting to the breast: who needs it and who does not
The BRAVA system is an expansion system you place on your breasts for 4+ weeks prior to surgery and then for a few weeks after surgery. The thought is BRAVA
- expands the skin envelope
- increases vascularity
- ? increases growth factors and other things to help the fat
- keeps pressure off the newly transferred fat
So does it work?
A study came out by Dr. Khouri in Miami, who I worked with last summer and saw his patients firsthand. The study was published in the May 2012 Journal of Plastic and Reconstructive surgery. It did volumetric MRIs of patients before and 6 months after surgery showing the degree of fat survival is higher than for other studies which did not use BRAVA. For my blog on this
I think for women who have tight skin- no kids yet, no breastfeeding, etc- they must stretch out their skin. Otherwise there is no "space" to graft into, the pressure will kill the newly transferred fat.
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The BRAVA is not required but it helps.
The BRAVA system in not required but it allows for a larger volume of fat to be transfered during a single session by expanding the breast tissue and increasing the blood supply. This leads to a higher percentage of fat survival and more grafted fat.
Without the BRAVA, about 150cc of fat can be transfered to each breast during a single session.
With the BRAVA, 250-300cc of fact can be transferred to each breast during a single session.
To be sure fat grafting is right for you, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.
When you call, ask if the plastic surgeon is trained and experienced in fat grafting. I hope this helps.
Brava system and fat grafting.
The Brava system is not necessary for successful fat transfer to the breasts. However, it may increase the viability of grafted fat reducing the total number of procedures necessary. Regardless, fat transfer is controversial in regards to breast augmentation due to the questions involved with breast cancer surveillance.
As for "storing" fat following harvest for future use, this is unlikely to occur in an office setting. Technically this would be banking of human tissue for later use and I would assume that certain regulations would require certification and licensure to able to do so. In short, I would be suspicious of any doctor claiming to save your fat for later use.
Fat grafting to the breast and brava bra
A brava bra will help get the best survival of the fat grafts. Without brava you will get some improvement of the breast size but it is not as predictable as with brava. For the best results possible, I would use brava. I don't think freezing fat is a good idea as it is not as reliable as fresh fat.
Brava and breast surgery
Is BRAVA necessary for fat transfer?
The BRAVA is not available at this time, so that makes your decision easy. I have had a few patients wear it when it was available, and it is cumbersome and difficult to wear, and I am not sure that it made any difference in the amount of fat that stayed.
Brava not required for fat transfer
BRAVA is a great tool to use with fat grafting!
Fat grafting is a valuable tool in breast surgery. This technique has gained more popularity over the past 7 years. There are many techniques used to harvest the fat, process the fat and then re-inject the fat. Conventional suction lipectomy is performed with a small diameter cannula, processed by separating the liquid and fibrous tissue from the fat, and then placed into syringes for re-injection or through a closed system.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.